Ann Dermatol.  2014 Dec;26(6):747-750. 10.5021/ad.2014.26.6.747.

Pigmented Mammary Paget Disease Misdiagnosed as Malignant Melanoma

• Lee JH
• Kim TH
• Kim SC
• Kim YC
• Roh MR

• KMID: 2264872
• DOI: http://doi.org/10.5021/ad.2014.26.6.747

Abstract

Pigmented mammary Paget disease is a very rare clinicopathologic variant of mammary Paget disease. Diagnosis is often difficult because its clinical and histological features are very similar to those of malignant melanoma. Herein, we report a case of pigmented mammary Paget disease misdiagnosed as malignant melanoma.

Keyword

Malignant melanoma; Mammary paget disease

MeSH Terms

Diagnosis
Melanoma*
Paget's Disease, Mammary*

Figure

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  Fig. 1 Clinical and dermoscopic features of pigmented mammary Paget disease. (A) Well-demarcated dark brown plaque on the nipple. (B) Dermoscopy shows irregular dots/globules, gray-blue pepper-like granules, and a scar-like appearance.

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  Fig. 2 Histologic and immunohistochemical features of pigmented mammary Paget disease. (A) Initial biopsy specimen showing large neoplastic epithelial cells with pigmentation and dermal melanophages (H&E, ×400). (B) Excision specimen showing intraepidermal proliferation of atypical cells with large hyperchromatic nuclei and pale cytoplasm (H&E, ×400). Tumor cells express immunoreactivity for (C) cytokeratin 7 (CK7, ×100) and (D) C-erbB2 (×100). Tumor cells show negative immunoreactivity for (E) HMB45 (×100) and (F) Melan-A (×100).

Reference

1. Azzopardi JG, Eusebi V. Melanocyte colonization and pigmentation of breast carcinoma. Histopathology. 1977; 1:21–30.

2. Yanagishita T, Tamada Y, Tanaka M, Kasugai C, Takahashi E, Matsumoto Y, et al. Pigmented mammary Paget disease mimicking melanoma on dermatoscopy. J Am Acad Dermatol. 2011; 64:e114–e116.

3. Saitoh K, Saga K, Okazaki M, Maeda K. Pigmented primary carcinoma of the breast: a clinical mimic of malignant melanoma. Br J Dermatol. 1998; 139:287–290.

4. Al-Daraji WI, O'Shea AM, Looi LM, Yip CH, Ellis I. Pigmented mammary Paget's disease: not a melanoma. Histopathology. 2009; 54:614–617.

5. Requena L, Sangueza M, Sangueza OP, Kutzner H. Pigmented mammary Paget disease and pigmented epidermotropic metastases from breast carcinoma. Am J Dermatopathol. 2002; 24:189–198.

6. Meyer-Gonzalez T, Alcaide-Martin A, Contreras-Steyls M, Mendiola M, Herrera-Acosta E, Herrera E. Pigmented mammary Paget disease mimicking cutaneous melanoma. Int J Dermatol. 2010; 49:59–61.

7. Soler T, Lerin A, Serrano T, Masferrer E, García-Tejedor A, Condom E. Pigmented paget disease of the breast nipple with underlying infiltrating carcinoma: a case report and review of the literature. Am J Dermatopathol. 2011; 33:e54–e57.